Background: Sore throat is a common presentation to the emergency department as well as primary care clinics. Corticosteroids inhibit transcription of pro-inflammatory mediators in airway endothelial cells responsible for pharyngeal inflammation and symptoms of pain. They have been used in other upper respiratory tract infections such as acute sinusitis and croup. In adults, previous studies with dexamethasone are in combination with antibiotics but studies of children have included dexamethasone without antibiotics. This study is unique as it is evaluating the benefits of oral corticosteroids for acute sore throat in primary care in the absence of antibiotics

Strengths:

Appropriate sample size to find a 18% increase in resolution with 90% power

Participants who had no information for the primary outcome were included in the analysis as having no resolution of symptoms

Primary outcome measure was collected from 93.6% of patients

Limitations:

A less severely ill patient population may be what was studied due to exclusion of patients requiring immediate antibiotics

Children were not studied in this trial

Primary outcome is not a well validated outcome

Study underpowered to detect a modest effect (<18%) on the primary outcome

Discussion:

Although there was no difference in the primary outcome of complete resolution of symptoms at 24 hours there was a significant difference in complete resolution of symptoms at 48 hours. When calculating the NNT this gives you a value of 12.

This study was underpowered for detecting a modest effect on the primary outcome.

A larger study could potentially identify a statistically significant different between treatments that could not be detected here.

The study was also not powered to detect a difference in adverse effect profiles.

Patients in this trial may not have been experiencing severe enough symptoms to receive benefit with dexamethasone.

Those participating in this study were excluded if they had symptoms or findings that were concerning for infection that required immediate antibiotics.

This could imply that patients were in general more sick and would have been better patients to benefit from corticosteroids.

Previous research supports this finding based on how corticosteroids have been used in other studies for adults and children.

Since this was a study in primary care, patients may not have as severe of symptoms as if they went to the emergency department.

Patients who present to the emergency department in general may be sicker than those who go to primary care.

For that potential reason, patients who present to the emergency department may be more likely to benefit just like we specified for those with more severe symptoms in general.

This could mean that the study is less applicable.

Author Conclusion: “Among adults presenting to primary care with acute sore throat, a single dose of oral dexamethasone compared with placebo did not increase the proportion of patients with resolution of symptoms at 24 hours. However, there was a significant difference at 48 hours.”

Clinical Take Home Point: Corticosteroids may play a beneficial role in sore throat just like in other upper respiratory infections but the effect is more likely to be beneficial in those with more severe symptoms.